**Theme Selected:** Adult-Gerontology Acute
Care Nurse Practitioner Exam 2024
**Target Question Count:** 75
**The Acute Continuum: NGN AGACNP Mastery**
---
1. 70-year-old, post-op day 3, sudden dyspnea, HR 120, SpO2 88% on 4L. CTA shows PE. BP 100/70.
Next?
💫RATIONALE✔️✔️: Submassive PE with right heart strain. Anticoagulation, monitor for hemodynamic
collapse.
💫ANSWER✔️✔️: C. Heparin drip and admit to ICU
---
2. 65-year-old, sepsis, MAP 55 on norepinephrine 0.2 mcg/kg/min. Lactate 4.5. Next step?
💫RATIONALE✔️✔️: Add vasopressin 0.03 units/min. Hydrocortisone if refractory.
💫ANSWER✔️✔️: B. Vasopressin 0.03 units/min
---
3. 80-year-old, community-acquired pneumonia, CURB-65 score 3. Admit to which level?
💫RATIONALE✔️✔️: CURB-65 ≥3 = severe pneumonia. ICU admission for respiratory monitoring.
💫ANSWER✔️✔️: D. Intensive care unit
---
4. 75-year-old, acute hypoxemic respiratory failure, P/F ratio 150 on PEEP 10. Next best intervention?
, 💫RATIONALE✔️✔️: Prone positioning reduces mortality in moderate-severe ARDS (P/F <150).
💫ANSWER✔️✔️: A. Prone positioning protocol
---
5. 68-year-old, COPD exacerbation, pH 7.29, PaCO2 70, on BiPAP 2 hours. No improvement. Next?
💫RATIONALE✔️✔️: Failed BiPAP = intubation. Avoid prolonged non-invasive failure.
💫ANSWER✔️✔️: C. Endotracheal intubation
---
6. 72-year-old, massive upper GI bleed, Hgb 6.0, BP 85/50, HR 120. Transfuse PRBCs. Next?
💫RATIONALE✔️✔️: Transfuse to Hgb >7 (or >9 if ACS). Reverse coagulopathy, IV PPI.
💫ANSWER✔️✔️: A. Pantoprazole IV bolus
---
7. 65-year-old, acute pancreatitis, Ranson score 5 on admission. ICU criteria met. Most concerning early
complication?
💫RATIONALE✔️✔️: Acute kidney injury and hypovolemia. Aggressive IV fluids (250-500 mL/hr).
💫ANSWER✔️✔️: D. Acute kidney injury
---
8. 78-year-old, acute kidney injury, oliguric for 12 hours, K+ 6.5, ECG peaked T waves. First action?
💫RATIONALE✔️✔️: Calcium gluconate for cardiac membrane stabilization. Then insulin/dextrose.
💫ANSWER✔️✔️: B. Calcium gluconate IV
---
9. 70-year-old, acute ischemic stroke, last known well 3.5 hours ago, NIHSS 12, BP 185/100. tPA
candidate?
💫RATIONALE✔️✔️: BP >185/110 contraindication to tPA. Lower BP with labetalol, then reconsider.
💫ANSWER✔️✔️: D. Give labetalol to lower BP
Care Nurse Practitioner Exam 2024
**Target Question Count:** 75
**The Acute Continuum: NGN AGACNP Mastery**
---
1. 70-year-old, post-op day 3, sudden dyspnea, HR 120, SpO2 88% on 4L. CTA shows PE. BP 100/70.
Next?
💫RATIONALE✔️✔️: Submassive PE with right heart strain. Anticoagulation, monitor for hemodynamic
collapse.
💫ANSWER✔️✔️: C. Heparin drip and admit to ICU
---
2. 65-year-old, sepsis, MAP 55 on norepinephrine 0.2 mcg/kg/min. Lactate 4.5. Next step?
💫RATIONALE✔️✔️: Add vasopressin 0.03 units/min. Hydrocortisone if refractory.
💫ANSWER✔️✔️: B. Vasopressin 0.03 units/min
---
3. 80-year-old, community-acquired pneumonia, CURB-65 score 3. Admit to which level?
💫RATIONALE✔️✔️: CURB-65 ≥3 = severe pneumonia. ICU admission for respiratory monitoring.
💫ANSWER✔️✔️: D. Intensive care unit
---
4. 75-year-old, acute hypoxemic respiratory failure, P/F ratio 150 on PEEP 10. Next best intervention?
, 💫RATIONALE✔️✔️: Prone positioning reduces mortality in moderate-severe ARDS (P/F <150).
💫ANSWER✔️✔️: A. Prone positioning protocol
---
5. 68-year-old, COPD exacerbation, pH 7.29, PaCO2 70, on BiPAP 2 hours. No improvement. Next?
💫RATIONALE✔️✔️: Failed BiPAP = intubation. Avoid prolonged non-invasive failure.
💫ANSWER✔️✔️: C. Endotracheal intubation
---
6. 72-year-old, massive upper GI bleed, Hgb 6.0, BP 85/50, HR 120. Transfuse PRBCs. Next?
💫RATIONALE✔️✔️: Transfuse to Hgb >7 (or >9 if ACS). Reverse coagulopathy, IV PPI.
💫ANSWER✔️✔️: A. Pantoprazole IV bolus
---
7. 65-year-old, acute pancreatitis, Ranson score 5 on admission. ICU criteria met. Most concerning early
complication?
💫RATIONALE✔️✔️: Acute kidney injury and hypovolemia. Aggressive IV fluids (250-500 mL/hr).
💫ANSWER✔️✔️: D. Acute kidney injury
---
8. 78-year-old, acute kidney injury, oliguric for 12 hours, K+ 6.5, ECG peaked T waves. First action?
💫RATIONALE✔️✔️: Calcium gluconate for cardiac membrane stabilization. Then insulin/dextrose.
💫ANSWER✔️✔️: B. Calcium gluconate IV
---
9. 70-year-old, acute ischemic stroke, last known well 3.5 hours ago, NIHSS 12, BP 185/100. tPA
candidate?
💫RATIONALE✔️✔️: BP >185/110 contraindication to tPA. Lower BP with labetalol, then reconsider.
💫ANSWER✔️✔️: D. Give labetalol to lower BP
